Respiratory infections

Question 1

most common bacterial organism causes of sinusitis

Answer 1

a. Streptococcus pneumoniae (30%)
b. Non-typeable Haemophilus influenzae (20%)
c. Moraxella catarrhalis (20%)

Question 2

when do the sinuses develop?

Answer 2

• ethmoidal and maxillary sinuses are present at birth, but only the ethmoidal sinuses are pneumatized
• Maxillary sinuses are not pneumatized until 4 years of age
• Sphenoidal sinuses present by age 5, frontal sinuses develop at age 7-8

Question 3

predominant symptom of sinusitis in young children

Answer 3

persistent nasal discharge > 10 days

Question 4

1st and 2nd line abx for sinusitis

Answer 4

1st amox, 2nd augmentin

Question 5

most common bacterial cause of pharyngitis is?

Answer 5

GAS

Question 6

which organisms could these findings along with pharyngitis point towards?

Answer 6

Gingiovostomatitis + ulcerating vesicles > HSV

Papuloveiscular lesions or ulcerations in posterior oropharynx > Herpangina caused by enteroviruses

Question 7

what is lemierre syndrome? typically caused by what organism?

Answer 7

septic thrombophlebitis of the internal jugular vein, usually caused by F. necrophorum

Question 8

peak age group of GAS pharyngitis

Answer 8

5-15 years, uncommon before 2-3yo

Question 9

what is important to note about antibiotics in GAS treatment, and its effect on the kidneys?

Answer 9

abx do prevent ARF, but not PSGN

Question 10

name some post-strep complications

Answer 10

GN
reactive arthritis
PANDAS

Question 11

why do retropharyngeal abscesses not commonly occur after 5 years old?

Answer 11

occurs most commonly in children < 3-4 years of age as retropharyngeal nodes involute after 5 years of age

Question 12

what is the normal retropharyngeal space in a <5yo?

Answer 12

Retropharyngeal space usually HALF the width of the adjacent vertebral body

Question 13

age group croup

Answer 13

6mo-6yo

Question 14

classic cxr sign for epiglottitis

Answer 14

thumb sign - enlarged epiglottis

Question 15

most common pathogen bacterial tracheitis

Answer 15

staph aureus

Question 16

features of severe pneumonia

Answer 16

empyema
severe resp distress
severe hypoxaemia/cyanosis
marked tachycardia
altered mental state

Question 17

Rx for pneumonia

Answer 17

not severe: amox TDS 3-5 days, or benpen if cant tolerate
severe: ceftx + fluclox

Question 18

bacterial tracheitis vs epiglottitis vs peritonsillar abscess vs retropharyngeal abscess

Answer 18

retropharyngeal abscess: 2-4yo. trismus, posterior wall bulge. reduced neck movement
peritonsillar abscess: >10yo, unilateral sore throat, hot potato voice
bacterial tracheitis: can lie flat, toxic
epiglottis: 3Ds - dysphagia, drooling and distress (tripod position)

Question 19

most common causative organism of round pneumonia

Answer 19

strep pneumoniae

Question 20

why is round pneumonia mostly a paediatric disease?

Answer 20

pore of Kohn are interalveolar communication
these develop as a child age but young children dont have them, so limited spread of infection > round pneumonia